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Nanaimo Blues Society
Membership Application Form

Please Select a Nanaimo Blues Society membership type:

$5.00 for youth
$10.00 for singles
$18.00 for a family

When you submit the form below someone will contact you regarding payment. Our on-line payment process is currently being developed and will be available soon.

First name: Last name:
Address:
City: Province: Postal Code:
Home Phone: Work Phone:
Mobile Phone: Fax:
Email Address:
Are you interested in volunteering? Yes: No:

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